EK: And since then, the Congress has stopped it from cutting doctor payments seven times since then. I went back through the record, and you voted for five of those delays.
PR: Oh, yeah! I think we should fix the thing. Don't get me wrong.
That has to do with the Medicare payments "fix," which Congress keeps postponing, often with Ryan's support. There is much more here. Cutting spending is hard!
Here are recent developments on cost containment in the health care bill.
Tyler, if you’re really interested in how Medicare should pay doctors, you may want to read this
http://www.npr.org/templates/transcript/transcript.php?storyId=124090475#commentBlock
It’s always good to have some historical background of what one is talking about.
What is interesting is that the Republicans are opposed to evidence based medicine, pay for performance and other rational ways to cut spending. They should embrace this. Employers benefit if the system as a whole changes to be more efficient.
This is a case of learning a bad lesson from the past and trying to copy it. Back in the 80′s, Senator Grassley and others sought to cut Medicare–fooled you–what he tried to do was to control the costs of medicare. But, what happened is that the democrats ran ads that the Republicans were “cutting Medicare”. He and others learned a lesson from this: if you try to rationally control costs, you will be demagogued on this. They learned too well: they turned it on the democrats when they tried to do this. Fair return, but the public is worse off.
Let’s hope that we can develop ways to control costs by improving efficiency and outcomes and that we can develop some bipartisan progam to do so.
Bill,
I’m all for it, but who is going to produce this evidence? Are academics going to provide the evidence of what works and only what has proven to work will be reimbursed? Kind of like how insurance companies already deny experimental procedures?
Also, paying for outcomes is not a panacea either to my mind. What is the first thing a doctor is going to do? Triage and not perform procedures on poor candidates based on their pre-existing complications. Maybe you are willing to live with those tradeoffs and it would be nice to hear more about the evidence concerning the downsides in addition to the benefits.
“What is interesting is that the Republicans are opposed to evidence based medicine”
Too many Republicans are bought and paid for by big pharma. Why do you suppose big pharma would be oppose to this?
MikeDC:
Reducing the amount that government is willing to pay doctors is not a price control any more than reducing the amount government is willing to pay Lockheed Martin for a new fighter jet is a price control. No one is forcing doctors to accept Medicare; they do it because it’s hugely profitable at current reimbursement rates.
But MikeDC, isn’t the way to cut medical spending requiring everyone to pay out of pocket, pockets that are empty?
MattMc, the Indiana “cost savings” result in zero cost savings to the State; the amount paid by the state for all the options are identical. The total for an individual is $X, and a family is $Y; the MSA account gets the difference between the insurance premium and $X or $Y if positive, the employee pays the difference if negative. Comparing the deductibles and copays for the $1500, the $3000, the real HMO, the classic PPO, the costs will be about the same over a lifetime. Depending on the rules, it might be worth it for younger workers to go with the high deductible until they need medical care, then switch to the HMO and use the MSA to pay the copays, but that rejects the idea of the high deductible insurance with MSA.
mulp,
That’s difficult to argue in this case since we’re talking about Medicare. Folks who get medicare are also getting a large generic subsidy in the form of Social Security payments. Hence, their pockets aren’t empty.
Beyond that, the bigger point is the provider cuts would also hit the pockets of seniors, simply a different distribution of them. In that case, some seniors lucky enough to get seen by the (decreased supply of) providers still pay a low price within the medicare system. Seniors forced to wait, travel, or go without do to the decreased supply must pay entirely out of pocket, with no reimbursement from their insurance. So you have a very unequal system of big winners and big losers.
If co-pays are raised, costs are spread more evenly, and a greater share of the rationing mechanism becomes an individual choice (do I pay), rather than non-market competition for Qs in shortage compared to Qd at the statutorily reduced rates.
I guess if doctors would suffer many payment cuts they will might not do their job right and the common man will have to suffer from that.There are many doctors who examine in derision if you do not give them some money.Atleast this happens in my country and I feel really sad to know and experience this.drug rehab Washington
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